The Combined Effect of Mindfulness and Physical Activity on Stress: A Systematic Review and Meta-Analysis of...

Interventions combining mindfulness and physical activity are increasingly used for stress management, but their average efficacy and incremental benefit over either component alone remain uncertain.

This study aimed to evaluate combined mindfulness-physical activity interventions for stress or stress-related outcomes relative to passive or general control conditions, mindfulness alone, and physical activity alone, and to explore potential sources of heterogeneity.

Following PRISMA 2020, eight electronic databases were searched through November 2025. Two reviewers independently screened records. Data extraction and the initial risk-of-bias assessment were performed by the first author and checked in full by a second reviewer. Risk of bias was assessed using RoB 1.0. Certainty of evidence was assessed using the GRADE approach. Hedges' g values were synthesised in three separate comparator-specific meta-analyses using restricted maximum-likelihood random-effects models with Knapp-Hartung adjustment.

Fourteen randomised controlled trials involving 872 randomised participants were included in the systematic review, and 13 contributed to quantitative synthesis. Compared with passive or general control conditions, combined interventions produced a statistically significant average effect favouring the combined intervention (k = 12; Hedges' g = -0.74, 95% CI -1.21 to -0.27; p = 0.006; I² = 83.1%; 95% prediction interval -2.27 to 0.79). The combined intervention was not statistically superior to mindfulness alone (k = 2; Hedges' g = 0.49, 95% CI -1.71 to 2.69) or physical activity alone (k = 3; Hedges' g = 0.01, 95% CI -0.50 to 0.52), although both comparisons were imprecise. No formal subgroup test identified a statistically significant moderator. Excluding the most extreme estimate reduced the pooled control-comparison effect to -0.55 (95% CI -0.79 to -0.31) and I² to 27.9%.

Combined mindfulness and physical activity interventions may reduce stress or stress-related psychological outcomes relative to passive or general controls. The current evidence is insufficient to determine whether they provide additional benefit over well-delivered single-component interventions. Substantial heterogeneity and the small number of active-comparator trials warrant cautious interpretation.